| NPI | 1770909780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS017844) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: PA OKO000055) |
| Enumeration Date | 2014-03-14 |
| Last Update Date | 2021-06-07 |